PMHNP---Help!

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    I've applied to a couple of PMHNP programs and been accepted to one. I should hear from the other school soon. I'm in such a dilemma. I thought for sure I would go this route but after some recent events I'm beginning to doubt my choice. I work in corrections where there are a LOT of psych patients. I'll cut to the chase with my concerns/fears. I'm wondering if I will be faced with the same types of patients but on the other side of the wall, so to speak. I've seen a lot of very sick individuals in jail...it recently dawned on me how vulnerable a PMHNP could be. How does one find the right fit for practice? I live in a small community; envisioned myself providing care for adolescents, maybe women...but now I'm fearful. Has anyone ever experienced this? I tend to see the criminally mentally ill folks and perhaps it has tainted my vision. Thanks for your feedback. I need to "get out of jail" and I want to make a positive transition. School is a HUGE financial and personal commitment. Thanks for any feedback or suggestions. I've always been drawn to psych but...
    blackbettyLPN likes this.
  2. 16 Comments so far...

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    What is it about being a PMHNP outside of a Jail or prison that scares you? I don't think you will be in any kind of danger, especially if your working in a practice with multiple providers. At least not in any more danger than any other kind of provider. On top of that in a private practice setting I'd imagine at least 90% of the patients are there voluntarily, actively seeking help.

    I'm far from an expert on the matter so I will enjoy seeing others opinions on this.
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    Thank you so much for your response. I am in desperate need of a change from this violent environment. I love mental health...have been drawn to it for many years. It feels like the right move for me but... I think my perception is a bit distorted based on the past 7 years in this field of offenders.
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    I can imagine that seeing the worst of society would do that to you. My wife is a CO at a county jail so I can sort of see where you are coming from.
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    Hi mtsteelhorse: I am a family PMHNP and currently practice in several different settings, one of which is in a county jail that houses federal inmates. I also work in a private for-profit hospital in the emergency department/inpatient psychiatric service as well as in nursing homes and a private practice, so I really get a good mix of patient populations and diagnoses. From my perspective, I really enjoy my work at the jail - I like the structure that this setting provides and the variety of pathology. In terms of safety, I feel very safe when I am seeing inmates at the jail. Honestly, I feel less safe when I am seeing patient in the emergency room. I recently saw a patient in my private outpatient setting who threatened to return to the office with a gun if I didn't provide him a refill on his Xanax...we had to call the police and evacuate the office after his mother called the office to warn us that he had in fact went home, got a gun and was planning to come back to the office. Working in psychiatry poses some unique challenges to safety, irrespective of the setting you are working in.

    Your question about finding the right fit for practice, I think you just have to try different populations / settings on for size and see how you feel. The beauty of psychiatry is that you can always change your practice setting if you want/need to. In terms of making a decision about whether or not psych is the way to go...thats a tough one. I was a clinical social worker before becoming a psych NP, so I knew this would fit my interests. Unfortunately, I have encountered a couple of colleagues who shared that they went the PMHNP route for the money, job security, etc. and they are miserable. I would encourage you to spend some time working in settings that are specific to psych (inpatient unit, outpatient mental health clinic, etc.) as my experience is that corrections and psych is a unique world. Best of luck to you!
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    PsychNM, you brought up my exact concern. I feel safer in the jail setting due to the high degree of security. My concerns have increased as I observe psych-type patients being incarcerated...the same folks being seen by mental health care providers in the community. Thank you so much for your kind and supportive words. I think it's fantastic you have so much diversity in your work. Can you share why your friends are miserable in psych? Do you work with a mental health service?

    Thanks again
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    Hi mtsteelhorse!
    Great points you're bringing up about working in a jail setting. I have never worked in a jail setting. I worked inpatient pscyh as well as on medical/psych locked units. I never felt unsafe. However, you have to be on your toes though. When it comes to jails and inpatient psych, they are "locked up" or inpatient because they are unstable. Otherwise, they wouldn't be locked up. In other words, the very fact that a person is inpatient psych should give a professional reason to use caution. You never know what could happen so you have to be prepared for unpredictible mood swings.....anger outbursts....triggers....flashbacks.......that sort of thing. You always have to be on your toes in terms of....personal space....distance from patient......out in open....close to exit way. I took a course years ago in crisis prevention and it was really helpful in teaching me how to recognize a potentially dangerous situation and then get out or divert it before it became out of control. A course like that could help you. Question: would you be willing to share the experience that you went through that has caused you to be more fearful now?
    For PsychNP............how long have your worked as psych NP? What do you like and dislike about it? Do you work in a rural or city setting? THanks for your input!!
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    mpolen6497, thanks for you comments. I've worked in the jail setting for just over 7 years. We are seeing an increase in mentally ill "clients." I think what has struck me recently is the number of inmates who are being seen by NPs on the outside. In other words, criminal behaviors get them locked up. The other thing that concerns me is the number and types of meds many of these folks are on. Long term benzos for example. Two recent events occurred that really made me pause. One was in the jail. I work solo in a clinic that looks out into the booking area and several observation cells. I have a secure office with blinds, etc. I go in and out of my office safely. This new inmate verbally attacked me in a way I have never been subject to. I was alone in my office and he was in his cell. There's no way he could physically get to me. He did however "get to me" on an emotional level. He yelled about how he was going to drag me to a field, rape me. leave me for dead...and other descriptive assaults too vile to post here. This went on for 90 mins. Come to find out later the weekend nurse had listened to this for 3 days. She spent the week at home sick to her stomach from the stress...and she's worked in psych and is a tough cookie. Anyhow, after all my experience this event was different. During the same week my daughter's best friend was urgently seen at the NP's office due to an escalation in her panic attacks and bipolar symptoms. Long story short when backs were turned she slit her wrist right there in the lobby. I guess these two events hit me pretty hard. I have felt a commitment to pursuing the mental health field but I really don't want to be a pill dispensary. I have to make some decisions soon. Thanks cyber friends...
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    I'm accepted at SLU! I'm going!!! Thanks guys...super excited!
    rninme likes this.
  11. 0
    I am still deciding which Masters program will best the best fit for me. I as far as PMHNP, my main concern is prescribing medication...yikes!! Now that you mention it, safety is also a concern.

    Any thoughts/advice?


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